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Automatic Identification System (AIS) is the de-facto communication standard used by vessels to broadcast identification and position information. However, being AIS communications neither encrypted nor authenticated, they can be eavesdropped and spoofed by adversaries, leading to potentially threatening scenarios. Existing solutions, including the ones conceived in the avionics domain, do not consider integration with the AIS standard, and they do not provide protection against rogue messages flooding. In this article, we propose Auth-AIS, a secure, flexible, standard-compliant, and backward-compatible authentication framework to secure AIS broadcast messages. Auth-AIS leverages existing sound cryptographic tools, including TESLA and Bloom Filters, inheriting their security properties while contextualizing them in the AIS technology. Auth-AIS is a software-only solution, that can be seamlessly integrated into existing AIS deployments, without requiring any hardware replacement. Its innovative design also provides backward-compatibility—i.e., Auth-AIS messages can be received also by AIS users not adopting Auth-AIS, while renouncing at its security guarantees. Auth-AIS can work in either two configuration modes: Deterministic Security Configuration, able to achieve low-delay authentication with a message overhead of 75 percent, or Probabilistic Security Configuration, reducing the message overhead down to 35.71 percent, while experiencing a marginal increase in the authentication delay. All these security configurations guarantee an 80 bits equivalent security level and false-positive rate less than 2--40. Note that these latter security parameters can easily be tuned to fit different security requirements. Finally, the source code of Auth-AIS in the GNURadio ecosystem has been released as open-source, to foster research activities from both Industry and Academia on secure AIS communications.

Objectives: Patients with Diabetic Kidney Disease (DKD) and foot ulcer have poor prognosis. However, no study have found association of diabetic foot ulcer (DFU) with diabetic kidney dysfunction and their co-existing risk factors. Materials and Methods: This cross sectional study collected the data for 10,680 patients for 15 years. All variables were analyzed biochemically and statistically by standardized methodology. Results: Levels of HbA1c, creatinine, systolic and diastolic blood pressures, microalbuminuria, spot urine protein, and spot urine protein to creatinine ratio were higher among the groups with foot ulcers (p-value < 0.0001 for all). Average ABI was observed to be lower among the groups demonstrating nephropathy and DKD (p=0.025 and 0.022 respectively. DFU was significantly associated with HTN (odds ratio 2.2; 95% CI 1.66 to 2.9; p < 0.0001), nephropathy (odds ratio 4.77; 95% CI 3.53 to 6.5; p < 0.0001) and DKD (odds ratio 4.77 and 6.83; 95% CI 4.6 to 10.2; p < 0.0001). HbA1c of 7.8% was 60% sensitive and 52% specific for the development of DFU. Creatinine of 1.2 mg/dl was 75% sensitive and 48% specific for DFU. Spot urine protein excretion from nephrons of 35 mg/dl was 88% sensitive and 90% specific for the development of DFU. Conclusion: Nephropathy/DKD are risk factors for the development of DFU. With optimal diabetes control, regular and routine assessment of the feet and early screening of diabetic patients for neuropathy, nephropathy, hypertension, dyslipidaemia and other diabetic complications are essential. Doi: 10.28991/SciMedJ-2021-0304-6 Full Text: PDF

Background Dental implant placement carries a risk of iatrogenic damage to adjacent root surfaces. Purpose To classify and understand different types of trauma to the tooth root body by dental implants. Materials and methods This prospective case series included 43 implants placed between February 2017 and June 2020 that had primary stability and were in a position that accidentally invaded the adjacent teeth. The type and degree of the injury were evaluated clinically and radiographically. Tenderness, mobility, and sensitivity tests of the injured teeth were conducted at different visits. Implant failure was confirmed by the presence of implant mobility during the healing period. Results Overall, 43 patients had root injuries due to dental implant surgeries. Regarding the 43 injured roots, 32 developed transient tenderness to percussion, 16 developed variable degrees of resorption in the cementum, three lost pulp sensitivity and one had persistent tenderness to percussion. No injured teeth were lost. In three patients, implant periapical lesions were confirmed radiographically as radiolucency near the apex of the involved implants. Out of the 43 implants, 11 failed and were removed within 6 months, with an implant failure rate of (25%). Conclusions Root damage after implant surgery varies depending on the type and severity of injury. Periodic clinical and radiographical examination is necessary to monitor root resorption and implant integration and to rule out pulp necrosis.

Common variable immunodeficiency (CVID) is one of the most prevalent primary immunodeficiencies. It is characterized by hypogammaglobulinaemia, increased susceptibility to infections and impaired vaccine responses. CVID has an important, clinical, immunological and genetic heterogeneity. A minority of patients present with monogenic forms in CVID, unlike other primary immunodeficiencies. With the development of new technologies in genetics, including next generation sequencing, the number of identified genes in CVID is increasing. Therefore, CVID is now considered as an umbrella disease, gathering distinct pathological entities. It is currently recognized that CVID is a complex polygenic rather than a monogenic syndrome. A multi-omic approach combining genomics, epigenetics and proteomics will shed light on CVID complex pathophysiology, which still enigmatic. This integrative approach will also offer more targeted therapies, and therefore a personalized medicine. This review aims to discuss current knowledge concerning the genetic and molecular bases of CVID as well as their application in clinical practice.

Data acquisition problem on large distributed wireless sensor networks (WSNs) is considered as a challenge in the growth of Internet of Things (IoT). Recently, the combination of compressive sensing (CS) and routing techniques has attracted much attention of researchers. An open question of this combination is how to integrate these techniques effectively for specific tasks. On the other hand, CS data reconstruction process is considered as one of the CS challenges because it requires to recover N data from only M measurement where M<

The present study evaluates the effects of Ginkgo biloba extract as monotherapy on the glycemic status, insulin resistance (IR), body mass index (BMI), and visceral adiposity index (VAI), in addition to the inflammatory markers, oxidative status and leptin level in patients with metabolic syndrome in comparison with metformin. The study is a randomized, double-blind pilot study conducted during the period May to September, 2020. Fifty patients were recruited in the study and they were allocated into two groups (25 per each group): Ginkgo biloba and Metformin groups, they received (120 mg Ginkgo biloba extract/ capsule) and (500 mg Metformin/ capsule) respectively; orally as a single dose for 90 days. Blood samples were taken at zero time and after 90 days and utilized for analysis of blood glucose, HbA1c, insulin and leptin levels, lipid profile, TAOS, hsCRP, TNF

Minimizing the quantity of transmitted data and protecting the devices from the adversary environment are the main challenges hindering the advancement of Internet of Things (IoT) network. Based on the theorem of unique prime factorization that any natural number can be expressed as the product of powers of prime numbers, we introduce a new scheme in this paper for secure and efficient gathering of the IoT data. The proposed scheme consists of three phases: Setup, Secure data gathering, and Data reconstruction. In the Setup phase, the properties of the prime numbers to create an efficient clustering and routing tree algorithm are utilized to reduce the power consumption during data transmission process. The Secure data gathering phase includes secure intra and inter communication procedures. During secure intra-communication procedure, the Compressive Sensing (CS) based method of data compression and encryption is used. Moreover, the prime number properties and the Bezier curve function are used to solve the CS problems. In the secure inter-communication procedure, the security performance of the IoT based Wireless Sensor Networks (WSNs) is improved by combining Private and Public key algorithms with the consideration of the power limitation of IoT devices. Finally, the proposed scheme introduces an adept reconstruction algorithm which is a hybrid algorithm of Bees and Genetic Algorithm to successfully restore the actual sensor data from the compressed samples, which improves the reconstruction process.

Summary Reaction kinetics between calcite and acid systems have been studied using the rotating disk apparatus (RDA). However, simplifying assumptions have been made to develop the current equations used to interpret RDA experiments to enable solving them analytically in contrast to using numerical methods. Previous work has revealed inadequacies of some of these assumptions, which necessitates the use of a computational fluid dynamics (CFD) model to investigate their impact on the RDA results. The objectives of the current work are to develop a calibrated CFD and proxy model to simulate the reaction in the RDA and use this model to estimate the diffusion coefficient and the reaction rate coefficient of the reaction in the RDA. The present work developed the first calibrated CFD model to determine the diffusion coefficient and the reaction rate coefficient in the RDA with minimum assumptions in the hydrochloric acid (HCl) carbonate reaction. More specifically, the model relaxes the constant fluid properties, infinite acting reactor boundaries, and constant reaction surface area assumptions. The proxy model obtained results in reduced computational time with minimal compromise on accuracy. Finally, the proposed model showed an improvement of 63% in predicting the reaction kinetics between calcite and HCl compared to traditional methods.

The emerging Internet of Things (IoT)‐based systems that integrate diverse types of sensors, mobiles and other technologies to physical world is becoming increasingly popular for use in wide varieties of applications. Compressive sensing (CS)‐based information acquisition and in‐network compression provide an effective method for accurate data recovery at the base station (BS) with reduced cost of communication. In this study, how CS can be combined with routing protocols for gathering data in IoT‐based Wireless Sensor Networks (WSNs) in an energy‐efficient manner are examined. A novel chain‐routing scheme with CS based data acquisition is introduced that includes the following new algorithms: (1) Seed Estimation Algorithm (SEA) to find the best measurement matrix by selecting the best‐estimated seed, (2) Chain Construction Algorithm (CCA) to organise the network nodes during transmitting and receiving process, (3) Compression approach with reduced consumption of energy that improves the lifetime of the network by minimising the local data traffic, and (4) Reconstruction Algorithm (RA) that reconstructs the original data with minimum reconstruction error. Here, extensive simulation and analysis results prove the performance of our proposed method in improving the network lifetime 35% better than the ECST algorithm and 93% better than the PEGASIS algorithm. In addition, the proposed reconstruction algorithm exceeds the other reconstruction algorithms performance.

Antibiotic resistance has become a major world health challenge and has limited the ability of physician's treatment. Staphylococcus aureus the most notorious pathogens causes morbidity and mortality especially in burn patients. However, Staphylococcus aureus rapidly acquired resistance to multiple antibiotics. Vancomycin, a glycopeptide antibiotic remains a drug of choice for treatment of severe Methicillin Resistance S. aureus infections. This study aimed to detect the emergence of beta-lactam and glycopeptide resistance genes. 50 clinical specimens of S. aureus collected from burn patients in burn and plastic surgery units in Sulaimani-Iraq city. All specimens were confirmed to be positive for S. aureus. All the isolates were assessed for their susceptibility to different antibiotics depending on NCCL standards, followed by Extended Spectrum Beta Lactamase detection by double disk diffusion synergy test. The production of ?- lactamases was evaluated in the isolated strains by several routine methods and polymerase chain reaction. Among the isolates 94% were Methicillin resistance and 34.28% were Extended Spectrum Beta Lactamase producer. PCR based molecular technique was done for the bla genes related to ?- lactamase enzymes by the specific primers, as well as genes which related to reduced sensitivity to Vancomycin were detected. The results indicated that all isolated showed the PBP1, PBP2, PBP3, PBP4, trfA and trfB, graSR, vraS except the vraR gene and the prolonged therapy of Methicillin resistance infection with teicoplanin have been associated with progress of resistance and the rise of tecoplanin resistance may be a prologue to evolving Vancomycin resistance. In conclusion, beta-lactam over taking can rise Vancomycin- Intermediate S. aureus strains leading to appearance of Vancomycin resistance although the treatment of Vancomycin resistant infections is challenging.

We combine in situ environmental transmission electron microscopy (E-TEM) with automated image processing and statistical machine learning to uniquely formulate interpretable mathematical models an...

Background: Obtaining an optimal surgical result depends on performing a technically proficient operation while protecting the heart from potential damage. Cardioplegia is an essential component in myocardial protection during aortic cross-clamping and cardiopulmonary bypass. The development of cardioplegia solutions is one of the major advances in cardiac surgery that allowed surgeons to extend the period of ischemic arrest to well over 3 hours to perform complex surgical procedures without adversely affecting myocardial functio).Aim of the work: We sought to compare between two specific modalities of myocardial protection using either intermittent ante-grade cold blood cardioplegia or warm blood cardioplegia.Patients and Methods: This prospective study included 200 successive adult patients who have undergone elective on-pump coronary artery bypass grafting (CABG) operations. Randomization was done immediately before the beginning of the operation so that group allocation was blinded to the patient. Participants were recruited between 14 January 2017 and 10 July 2019 at Mahalla Cardiac Center. All patients were thoroughly evaluated preoperatively, intraoperatively, and postoperatively.Results: There was no statistically significant difference between the two groups as regards bypass and cross clamp times. However, there was a statistically significant difference between the two groups as regards spontaneous defibrillation. There were no significant differences in both groups regarding the needed either inotropic support, or an IABP to achieve weaning. The total period of mechanical ventilation was statistically shorter in the warm group compared to the cold group.Conclusion: We found that there was no difference in the clinical effect of warm or cold blood cardioplegia despite the relative increase in postoperative serum cTnI in the warm cardioplegia group. Both strategies appear to allow a comparable and satisfactory method for myocardial protection during the period of cardiac arrest.

During the last 4 decades, registration of patients with primary immunodeficiencies (PID) has played an essential role in different aspects of these diseases worldwide including epidemiological indexes, policymaking, quality controls of care/life, facilitation of genetic studies and clinical trials as well as improving our understanding about the natural history of the disease and the immune system function. However, due to the limitation of sustainable resources supporting these registries, inconsistency in diagnostic criteria and lack of molecular diagnosis as well as difficulties in the documentation and designing any universal platform, the global perspective of these diseases remains unclear.Published and unpublished studies from January 1981 to June 2020 were systematically reviewed on PubMed, Web of Science and Scopus. Additionally, the reference list of all studies was hand-searched for additional studies. This effort identified a total of 104614 registered patients and suggests identification of at least 10590 additional PID patients, mainly from countries located in Asia and Africa. Molecular defects in genes known to cause PID were identified and reported in 13852 (13.2% of all registered) patients.Although these data suggest some progress in the identification and documentation of PID patients worldwide, achieving the basic requirement for the global PID burden estimation and registration of undiagnosed patients will require more reinforcement of the progress, involving both improved diagnostic facilities and neonatal screening.

Objective The present study was designed to evaluate the anti-inflammatory effects of different doses of aliskiren in two animal models of inflammation. Methodology Sixty-six Wistar rats were allocated into five groups: the first group (six rats) was treated with the vehicle only, without induction of paw edema and granulomatous inflammation, and served as a negative control; the second group (12 rats) was allocated into two subgroups and treated with the vehicle only, with induction of paw edema and granulomatous inflammation, and served as a positive control; the third group (36 rats) was allocated into six subgroups and treated with different doses of aliskiren (15, 30, and 60 mg/kg) in both models; the fourth group (12 rats) was treated with dexamethasone (1 mg/kg) in both models of inflammation. Serum concentrations of tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), vascular cell adhesion molecule-1 (VCAM-1), and high sensitivity C-reactive protein (hs-CRP) were measured. Skin samples were also sent for histopathological examination. Results Aliskiren, in a dose-dependent pattern, significantly decreased inflammation in rat models of inflammation, by attenuating the percentage of exudate, granuloma, and paw edema. Furthermore, it significantly reduced serum concentrations of TNF-α, VCAM-1, and hs-CRP and restored the serum concentration of IL-10. Additionally, significant improvement was seen in the histopathological findings. Conclusion In the current study, aliskiren was successful in decreasing inflammation in both models. These findings suggest that aliskiren is a good candidate for the treatment of inflammatory diseases.

Objectives: To evaluate the hemodynamic and recovery characteristics of dexmeditomidine and propofol in dilatation and curettage. Study Design: Randomized control trial. Setting: Department of Anaesthesia, DHQ Teaching Hospital Sargodha. Period: March 2016 to December 2017. Material & Methods: Patients undergoing dilatation & curettage were randomly divided into two groups, group P received IV propofol 1.5mg/kg slowly over 5 min and group D received dexmeditomidine at a loading dose of 1µg/kg followed by 0.5 µg/kg/h. During the procedure blood pressure and heart rate were compared in both groups. In the recovery room, recovery time was compared in both groups by using modified aldrete score. Results: In Group D, the decrease in heart rate was statistically significant when compared with group P. Both groups showed a decrease in MAP but results were not statistically significant when compared in both groups. Patients in group D were discharged earlier from recovery room than group P and results were statistically significant. Conclusion: Dexmeditomodine provides better recovery than propofol so it is a suitable drug for day care minor surgical procedures. Similarly dexmeditomidine is superior to propofol by providing less respiratory depression intraopertaively.

Background: early cancers are managed by single modality treatment (surgical excision of the primary tumor or radiotherapy (3DCRT, IMRT or brachytherapy)) with or without elective neck dissection. While locally advanced resectable disease is managed by surgery (excision of the primary tumor with modified radical neck dissection) followed by postoperative radiotherapy with or without chemotherapy. This should be considered for cases with adverse pathological features. Purpose: this is a retrospective study to analyze the epidemiological, pathological and clinical factors in cancer oral tongue and correlate them to clinical outcomes [response to treatment and survival rates (disease free survival, progression free survival and overall survival)] to explore best options of care for the patients. Patients and Methods: at the Department of Clinical Oncology and Nuclear Medicine, Ain Shams University Hospitals and Nasser Institute, Cancer Center; patients with a histologically confirmed diagnosis of oral tongue cancer were included in this retrospective analysis. The study included 40 cases from Nasser Institute, Cancer Center and 18 cases from Ain Shams University Hospitals. The study period was 6 years from January 2011 to December 2016. Results: fifty eight recorded cases were included in the study and subsequent descriptive analysis was performed. One patient who didn’t receive any treatment was omitted from the study. Conclusion: as regard treatment; most of the patients underwent surgery followed by adjuvant concurrent chemo radiotherapy especially in patients with close or positive surgical margins or patients who didn’t undergo LN dissection. This affected DFS.

Objectives: In Laparoscopic surgery placement of primary port is an important step and is often associated with complications. Our objective is to compare the merits and demerits like safety, efficacy of the site, time of entry of the port, per-operative and post-operative complications of infrumbilical (IU) with transumbilical (TU) approach for placement of this port. So on the basis of best clinical evidence get a clinical direction for a better site for placement of primary port. Study Design: A prospective randomized controlled trial of 238 patients. Setting: Surgical unit II of DHQ Hospital/ Sargodha Medical College (University of Sargodha) Sargodha. Period: June 2015 to December 2017. Material & Methods: Patients aged 16-70 years, fit for surgery, under general anesthesia were included in this study after informed consent. Patients who were unfit for general anaesthesia, who were Imuno-compromised, diabetics, CLD, with ascites, patients with suspected malignancy, with previous surgery in the umbilical region like midline laparotomy scar, previous hernia repair in this region were excluded from this study. Permission was sought from and granted by institutional ethical committee. Results: A total number of 238 patients were included. Group A (Trans-Umbilical) and Group B (Infra-Umbilical) contained 119 cases each. There were 147 female and 91 male. (M: F ratio of 1: 1.615). Conclusion: Based on results from this study and previous literature, it may be concluded that Transumbilical (TU) placement of primary port for creation of pneumoperitoneum is superior to infrumbilical (IU) approach.

Introduction: Type I diabetes (T1D) is an autoimmune disease with a prediabetic, asymptomatic period characterized by the selective destruction of insulin-producing β cells. During the pre-clinical phase, various auto-antibodies are generated against several beta cell antigens such as anti glutamate acid decarboxylase (Anti-GAD), anti tyrosine phosphatase (Anti-IA2). Today, the coupled detection of Anti-IA2 with that of Anti-GAD proves its great importance in the diagnosis and prediction of type 1 diabetes. The combined positivity for both antibodies has a specificity and a positive predictive value of 100%. Objectives: In this work, we evaluate the diagnostic value of anti-GAD and anti-IA2 antibodies in a series based on 78 Moroccan subjects initially under 16, suspected T1D. Results and Discussion: Our series consists mainly of 74% of newly diagnosed patients for T1D and 26% of confirmed diagnostic patients, of whom 52% are females. The mean age of diagnosis is 7 ± 4 years, the mean of HbA1c at the time of diagnosis is 11.63 ± 2.16%, and the percentage of family history in our series is 69%. The proportion of positive results for anti-IA2 antibodies and anti-GAD antibodies are, respectively, 76.92% and 62.82%, and 52.56% of patients are positive for both auto-antibodies. This study confirms that anti-GAD and anti-IA2 auto-antibodies assays can detect patients early and the autoantibodies can persist several years after diagnosis of type 1 diabetes. Conclusion: This study confirmed the diagnosis and classification of T1D (type 1A) in 87.18% of patients, and we reported that the prevalence of anti-GAD and anti-IA2 is higher in girls than in boys. Keywords: Type 1 diabetes; autoimmunity; autoantibodies; anti-GAD; anti-IA2; ELISA; classification.

Background Coronary vascular dysfunction is a common cause of symptoms in patients with angina and no obstructed coronary arteries (ANOCA). Several endotypes have been defined but there are big gaps in our understanding of the underlying pathophysiology. Proteomic analyses may improve the understanding of the pathophysiology. Purpose Exploratory approach to 1) compare the proteomic biomarker profile across different types of vascular dysfunction in ANOCA and 2) assess the value of prediction models with protein biomarkers for vascular dysfunction in ANOCA. Methods We included 107 angina patients without previous coronary artery disease, left ventricular ejection fraction >45% and no obstructive coronary artery disease (CAD) ( Results CFVR was correlated to 24 biomarkers before (figure 1a) and 2 biomarkers after adjustment for age and gender. The basic prediction model had AUC of 0.68 and was not significantly improved by adding biomarkers (figure 2a). RHI was correlated to 27 biomarkers before (figure 1b) and 10 biomarkers after adjustment for age and gender. The clinical prediction model was significantly improved (p=0.037) by adding TRAIL R2 and IL-18, in addition to age and gender, with an AUC of 84.4 (figure 2b). VMD was correlated to 14 biomarkers before (figure 1c) and 6 biomarkers after adjustment for age and gender. The prediction model was significantly improved (p=0.011) by adding HSP-27, RARRES-2 and SERPINA-12 in addition to age and gender in prediction of VMD with an AUC of 85.4 (figure 2c). Conclusion Several biomarkers were associated with vascular dysfunction in ANOCA patients with little overlap between different endotypes. We identified biomarkers that may contribute to the understanding of the underlying pathophysiology and have applications for screening. Results need to be confirmed in larger studies. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark.Department of Cardiology and Angiology, Robert Bosch Krankenhaus, Stuttgart, Germany

Background: Target lesion failure remains an issue with contemporary drug-eluting stents. Thus, the dual-therapy sirolimus-eluting and CD34+ antibody–coated Combo stent (DTS) was designed to further improve early healing. This study aimed to investigate whether the DTS is noninferior to the sirolimus-eluting Orsiro stent (SES) in an all-comers patient population. Methods: The SORT OUT X (Combo Stent Versus Orsiro Stent) trial, was a large-scale, randomized, multicenter, single-blind, 2-arm, noninferiority trial with registry-based follow-up. The primary end point target lesion failure was a composite of cardiac death, myocardial infarction, or target lesion revascularization within 12 months, analyzed using intention-to-treat. The trial was powered for assessing target lesion failure noninferiority of the DTS compared with the SES with a predetermined noninferiority margin of 0.021. Results: A total of 3146 patients were randomized to treatment with the DTS (1578 patients; 2008 lesions) or SES (1568 patients; 1982 lesions). At 12 months, intention-to-treat analysis showed that 100 patients (6.3%) assigned the DTS and 58 patients (3.7%) assigned the SES met the primary end point (absolute risk difference, 2.6% [upper limit of 1-sided 95% CI, 4.1%]; P (noninferiority)=0.76). The SES was superior to the DTS (incidence rate ratios for target lesion failure, 1.74 [95% CI, 1.26–2.41]; P =0.00086). The difference was explained mainly by a higher incidence of target lesion revascularization in the DTS group compared with the SES group (53 [3.4%] vs. 24 [1.5%]; incidence rate ratio, 2.22 [95% CI, 1.37–3.61]; P =0.0012). Conclusions: The DTS did not confirm noninferiority to the SES for target lesion failure at 12 months in an all-comer population. The SES was superior to the DTS mainly because the DTS was associated with an increased risk of target lesion revascularization. However, rates of death, cardiac death, and myocardial infarction at 12 months did not differ significantly between the 2 stent groups. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03216733.

Background: Chemoradiotherapy have an important role in the treatment of locally advanced head and neck cancers, in old age patients with, renal and cardiac dysfunction ineligible for cisplatin, We compared weekly Taxol versus weekly carboplatin .AIM: Our study aiming to comparing the efficacy and toxicities of chemo radiotherapy of weekly Taxol versus weekly carboplatin in locally advanced head and neck carcinoma. PATIENT AND METHODS: The study divided in two arms, paclitaxel arm; 25patients treated by weekly paclitaxel 40mg/m2 with radiotherapy and carboplatin arm; 25 patients treated by weekly 150mg carboplatin with radiotherapy. The three-dimensional radiotherapy planned (3DCRT) was 65 to 70 GY and 1.8 -2 GY /fraction, 5 fractions/week in 6-7 weeks. RESULTS: There was an insignificant 5-year disease free survival was 79.5% in carboplatin arm versus 84.6% in paclitaxel arm and 5-year OS was an insignificant 76% in carboplatin arm versus 72% in paclitaxel arm (p-value=0.646) . A 44% of both arms had overall complete remission. A 16% of patients received carboplatin had grade III/IV mucositis. Patients in paclitaxel arm had more grade II neuropathy (60%). A comparable rate of neutropenia had occurred in both arms. CONCLUSION: Both arms of concurrent chemo radiotherapy had acceptable toxicities with good quality of life response to treatment where 44% of both arms had complete response (p-value=0.623). There was an insignificant 5-year disease free survival was 79.5% in carboplatin arm versus 84.6% in paclitaxel arm and 5-year OS was an insignificant 76% in carboplatin arm versus 72% in paclitaxel arm (p-value=0.646).

Achieving glycemic control and targets are challenging in type-1 diabetes management. To achieve this, intensive insulin therapy or multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) or pump therapy have been used in various health care settings. However, there has been a debate on their superiority. Some of researchers have recommended MDI, while others SCII. We compared MDI with CSII by a literature search. We have conducted mata-analysis for MDI and CSII on ten randomized controlled trials on 809 type-1 diabetics 809, MDI (N = 394) or CSII (N = 415). Heterogeneity between trials was quantified by conventional Q-statistic (Cochran’s heterogeneity statistic) and Higgins I2 statistic with 0-40% representing negligible heterogeneity, 30-60% moderate heterogeneity, 50-90% substantial heterogeneity and 75-100% considerable heterogeneity. tau-squared (τ2) was used to observe between-study random-effects variance. Meta Analyst software was used to analyze the data and to conduct meta-analysis. SPSS was used to analyze HbA1c student’s t-test for MDI and CSII. A random-effect analysis ((DerSimonian-Laird method) performed on ten studies found that the percentage of HbA1c was lower in patients receiving CSII compared with those receiving MDI; standardized mean difference (SMD) was 0.441, 95% confidence interval 0.267 to 0.616, p

Objectives To evaluate the clinical performance and the effect of various patient and provider-related factors on the longevity of chairside monolithic posterior lithium disilicate glass-ceramic (LDGC) computer-aided design (CAD)-computer-aided manufacturing (CAM) crowns provided by predoctoral students. Materials and methods A sample of posterior LDGC CAD-CAM crowns was evaluated. Crown preparations were milled chairside using the CEREC Omnicam system and cemented with Rely-X Unicem or Calibra Universal resin cements. Clinical assessment of the crowns and supporting periodontal structures was performed using the modified California Dental Association (CDA) criteria. Intraoral photographs as well as radiographs were taken for further assessment by two evaluators. Kaplan-Meier survival analysis was performed. Results A total of 40 crowns were inserted in 32 patients and evaluated for 4 years. Three complications were observed (two-technical and one-biological). No chipping or fracture of crowns was observed. No significant association was found between age, sex, periodontal condition, tooth type, tooth vitality, cement type, and longevity. The 4-year cumulative survival and success rates were 95.0 and 92.3%, respectively. Conclusion Chairside LDGC CAD-CAM crowns exhibited a high survival rate after 4 years in function and were shown to be a viable and reliable treatment option for posterior teeth. Clinical significance The high survival rate of chairside CAD-CAM crowns observed in this study suggests the likelihood of predictable performance in the predoctoral setup.

Maternal preconceiving nutrition is thought to affect fertility outcomes. The current emphasis on the omega-3 fatty acids, which has been associated with improved fertility in both spontaneous and assisted reproduction conceptions. This study aims to evaluate the role of preconceiving omega 3 polyunsaturated fatty acids supplementation in enhancing the proportion between follicles and retrieved ova, the fertilization rate, and the embryonic grading in subfertile females experiencing intracytoplasmic sperm injection management protocols. One-hundred twenty subfertile women aged 20-40 years-old undergoing intra-cytoplasmic sperm injection were recruited in this randomized double-blinded placebo-controlled clinical trial, at Fertility Center/ Al-Sadr Teaching Hospital/ Al Najaf/ Iraq. They were randomly assigned into two groups; group A (omega-3) includes 60 subfertile women who received one capsule 1000mg omega-3 and Group B (placebo) includes 60 subfertile women who received a placebo contain Liquid Paraffin 500mg for eight weeks. The number of follicles, number of oocytes, fertilization rates, and embryonic quality were recorded in both groups. The study result revealed that the ratio of follicle/retrieved oocyte, the number of metaphase II oocytes, fertilization rate, and grade I embryo were more in the group A compared to group B. Supplementation with Omega-3 polyunsaturated fatty acids can increase the ratio of follicle/retrieved oocyte, the number of metaphase II oocytes, fertilization rate, and grade I embryo, and thereby improving the pregnancy outcome in intracytoplasmic sperm injection cycles.

Aims Many patients with angina, especially women, do not have obstructive coronary artery disease (CAD) yet have impaired prognosis. We investigated whether routine assessment of coronary microvascular dysfunction (CMD) is feasible and predicts adverse outcome in women with angina and no obstructive CAD. Methods and results After screening 7253, we included 1853 women with angina and no obstructive CAD on angiogram who were free of previous CAD, heart failure, or valvular heart disease in the prospective iPOWER (Improving Diagnosis and Treatment of Women with Angina Pectoris and Microvascular Disease) study. CMD was assessed by Doppler echocardiography in the left anterior descending artery as coronary flow velocity reserve (CFVR). Patients were followed for a composite outcome of cardiovascular death, myocardial infarction (MI), heart failure, stroke, and coronary revascularization. CFVR was obtained in 1681 patients (91%) and the median CFVR was 2.33 (quartiles 1–3: 2.00–2.74). During a median follow-up of 4.5 years, 96 events occurred. In univariate Cox regression, CFVR was associated with the composite outcome {hazard ratio (HR) 1.07 [95% confidence interval (CI) 1.03–1.11] per 0.1 unit decrease in CFVR; P Conclusion Assessment of CFVR by echocardiography is feasible and predictive of adverse outcome in women with angina and no obstructive CAD. Results support a more aggressive preventive management of these patients and underline the need for trials targeting CMD.

ObjectivesCoronary microvascular dysfunction (CMD) is considered to cause angina pectoris in a large proportion of women with no obstructive coronary artery disease (CAD). However, data supporting a relation between angina pectoris and CMD are limited. We compared CMD in women with angina with asymptomatic women and evaluated the relation between presence of CMD, angina characteristics, cardiovascular risk factors and results of stress testing.MethodsIn a cross-sectional study, we included 1684 women with angina and ResultsMedian CFVR was 2.33 (IQR 2.00–2.75) in symptomatic women versus 2.60 (2.19–2.95) in asymptomatic (p=0.007). CFVR ConclusionsImpaired CFVR is more prevalent in symptomatic than in asymptomatic women and related to the cardiovascular risk factors hypertension, diabetes, smoking and increased heart rate. Neither a positive bicycle test, single photon emission CT stress test nor chest pain characteristics identify women with impaired CFVR among women with angina and no obstructive CAD. Results may question the concept of microvascular angina as currently defined.

Pediatric sepsis is associated with high mortality rates. The mortality is even higher in low income countries, therefor, implementation of simplified protocols of recognition, evaluation and management is crucial. These protocols must be tailored to local resources. We suggest in this letter a practical protocol allowing rapid transfer of pediatric sepsis patients to the PICU.

BACKGROUND: Although autoimmunity and hyperinflammation secondary to recombination activating gene (RAG) deficiency have been associated with delayed diagnosis and even death, our current understanding is limited primarily to small case series. OBJECTIVE: Understand the frequency, severity, and treatment responsiveness of autoimmunity and hyperinflammation in RAG deficiency. METHODS: In reviewing the literature and our own database, we identified 85 patients with RAG deficiency, reported between 2001 and 2016, and compiled the largest case series to date of 63 patients with prominent autoimmune and/or hyperinflammatory pathology. RESULTS: Diagnosis of RAG deficiency was delayed a median of 5 years from the first clinical signs of immune dysregulation. Most patients (55.6%) presented with more than 1 autoimmune or hyperinflammatory complication, with the most common etiologies being cytopenias (84.1%), granulomas (23.8%), and inflammatory skin disorders (19.0%). Infections, including live viral vaccinations, closely preceded the onset of autoimmunity in 28.6% of cases. Autoimmune cytopenias had early onset (median, 1.9, 2.1, and 2.6 years for autoimmune hemolytic anemia, immune thrombocytopenia, and autoimmune neutropenia, respectively) and were refractory to intravenous immunoglobulin, steroids, and rituximab in most cases (64.7%, 73.7%, and 71.4% for autoimmune hemolytic anemia, immune thrombocytopenia, and autoimmune neutropenia, respectively). Evans syndrome specifically was associated with lack of response to first-line therapy. Treatment-refractory autoimmunity/ hyperinflammation prompted hematopoietic stem cell transplantation in 20 patients. CONCLUSIONS: Autoimmunity/hyperinflammation can be a presenting sign of RAG deficiency and should prompt further evaluation. Multilineage cytopenias are often refractory to immunosuppressive treatment and may require hematopoietic cell transplantation for definitive management. (C) 2019 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.

Accurate short-term forecasts are indispensable for the integration of wind energy in power grids. On a wind farm, local wind conditions exhibit sizeable variations at a fine temporal resolution. Existing statistical models may capture the in-sample variations in wind behavior, but are often shortsighted to those occurring in the near future, that is, in the forecast horizon. The calibrated regime-switching method proposed in this paper introduces an action of regime dependent calibration on the predictand (here the wind speed variable), which helps correct the bias resulting from out-of-sample variations in wind behavior. This is achieved by modeling the calibration as a function of two elements: the wind regime at the time of the forecast (and the calibration is therefore regime dependent), and the runlength, which is the time elapsed since the last observed regime change. In addition to regime-switching dynamics, the proposed model also accounts for other features of wind fields: spatio-temporal dependencies, transport effect of wind and nonstationarity. Using one year of turbine-specific wind data, we show that the calibrated regime-switching method can offer a wide margin of improvement over existing forecasting methods in terms of both wind speed and power.

The use of ceramic materials and the computer-aided design/computer-aided manufacturing (CAD/CAM) technology for the fabrication of complete-coverage restorations has significantly increased in the last decade. The aim of this study was to evaluate the survival rate of anterior and posterior monolithic and bilayered lithium disilicate glass-ceramic (LDGC) CAD/CAM crowns, and to identify the types of complications associated with the main clinical outcomes reported in clinical trials. MEDLINE/PubMed, Embase, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched by 2 independent reviewers for clinical studies published between 2006 and 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The electronic search was supplemented by a hand search. Quality assessment for the included studies was performed. Qualitative and quantitative data was extracted from each study. Out of 219 studies, 6 studies that evaluated LDGC CAD/CAM crowns were identified and used for data extraction. The included studies had 154 participants, who received 204 crowns. The shortto medium-term survival and success rates were high. Biological complications occurred more frequently than technical complications. No esthetic complications were reported. This review indicated that the medium-term survival rate of LDGC CAD/CAM crowns was high. Further multicenter studies with longer follow-ups and larger sample sizes are needed in order to augment the data already in existence.

Since December 2019, a rapid increase in the number of SARS-CoV-2 (COVID-19) cases was reported worldwide, despite strict infection control and lock down measures. Current paper investigated the actual facts behind this rapid increase in the number of cases. Study of genomic sequence reveals that domestic and wild animals were likely ancestors and zoonotic source for SARS-CoVs, MERS-CoVs, and SARS-CoV-2. Strong evidence suggest that these viruses already existed and replicated in animals and humans during past several decades, exhibiting diverse mutations, evolutions and self-limiting diseases, except during outbreaks. Serious zoonotic reservoir investigations are required to investigate animal transmission of SARS-CoVs and SARS-CoV-2 to limit current pandemic. This might be the reason of increasing number of cases via animals. SARS-CoV-2 has been retrospectively isolated in different studies in August 2019, several months before Wuhan announced. Hence, there is a possibility that viruses existed, went undetected, infecting subclinically, in past several years, and SARS-CoV-2 antigens and neutralizing antibodies may have been present in humans since long time. This might be another reason of increasing number of cases by screening as mass screening and antigen or antibody testing was not carried out in the past years. Randomized controlled trials are required to investigate human to human transmission by touch, as the current evidence is limited with conflicting results. As all SARS-CoVs are basically respiratory viruses, droplet precautions and infection control measures are essential, especially for hospital staff. Increased number of SARS-CoV-2 asymptomatic, or subclinical cases are detected worldwide. This silent phase of transmission can be beneficial for humans. Lack of symptoms eventually lessen virus transmission and reduce the pathogen's long-term survival and provide humoral herd immunity up to several years. Hence, seropositivity with diverse antibodies develops against mutating SARS-CoVs which will confer strong immunity during epidemics. Strategies such as identification, contact tracing and quarantine are costly and practically difficult. Hence, asymptomatic persons can continue their work with droplet precautions and standard infection control procedures, while symptomatic or sick persons can isolate themselves in their homes without the need for strict quarantine until clinical recovery, with reduced hospital visits and minimizing chances of hospital acquired infections. RT-PCR has low sensitivity and specificity, carries a high risk of handling live virus antigens, and requires difficult protocols. As viral load also sharply declines after few days of onset of infection, this technique might overlook infection. Furthermore, SARS-CoV-2 infection may be present in blood when oropharyngeal swabs are negative by RT-PCR. Additionally, RT-PCR usually gives false negative and false positive results and must be interpreted cautiously. This might be again a reason of increasing number of cases by false positive RT-PCR reporting. Moreover, antibodies against SARS-CoVs develop robustly in serum even by reduced amount of antigens. In contrast to RT-PCR, ELISA for diagnosing antibodies against SARS-CoV-2 demonstrates 100% specificity and 100% sensitivity, even in clinically asymptomatic individuals. These antibodies can be used for serologic surveys, monitoring and screening. However, screening tests for SARS-COV-2 should be avoided in unhygienic public places by nasopharyngeal swabs, which carry a high risk of further transmission, co-infection or superinfection. Such highly infectious virus must be isolated and tested in highly sterilized laboratory. Further strict international laws and policies are required to stop the possible spread of experimental viruses, biological warfare and bioterrorism.

It has been cited in the research that patients with diabetic kidney disease (DKD) and foot ulcer have poor prognosis; and foot ulceration is associated with kidney dysfunction. However, no study have found association of diabetic foot ulcer (DFU) with diabetic kidney dysfunction and their co-existing risk factors including blood pressure, serum creatinine, microalbumin, spot urine protein, HbA1c and associations of nephropathy and DKD with low ankle brachial index (ABI). We monitored, collected and analyzed the data for 10,680 patients for a duration of more than 13 years. 12% of patients demonstrated DFU. Nephropathy was observed in 39% of patients; 43% was hypertensive while 15% demonstrated DKD or CKD. Levels of HbA1c, creatinine,, systolic and diastolic blood pressures, microalbuminuria, spot urine protein, and spot urine protein to creatinine ratio were higher among the groups with foot ulcers (p-value < 0.0001 for all). Average ABI was observed to be lower among the groups demonstrating nephropathy and DKD with significant p-values (p=0.025 and 0.022 respectively). Pearson’s χ2 and logistic regression with odds ratio were also analyzed for DFU with HTN, nephropathy and DKD. DFU was significantly associated with HTN (odds ratio 2.2 ; 95% CI 1.66 to 2.9; p < 0.0001), nephropathy (odds ratio 4.77 ;95% CI 3.53 to 6.5; p < 0.0001) and DKD (odds ratio 4.77 and 6.83; 95% CI 4.6 to 10.2; p < 0.0001). ROC was used to find out cutoff values, sensitivity and specificity. HbA1c of 7.8% was 60% sensitive and 52% specific for the development of DFU (AUC = 0.58; 95% CI 0.521 to 0.624; p < 0.0006). Creatinine of 1.2 mg/dl was 75% sensitive and 48% specific for DFU (AUC = 0.58; 95% CI 0.640 to 0.715; p < 0.0001). Spot urine protein excretion from nephrons of 35 mg/dl was 88% sensitive and 90% specific for the development of DFU (AUC = 0.585; 95% CI 0.555 to 0.616; p < 0.0001). Our data has demonstrated the first time such associations and confirmed that nephropathy or renal failure are risk factors for the development of DFU. HbA1c should be optimal and near to the targets to improve wound healing. Our study has prompted diabetologists for regular and routine assessment of the feet and early screening of diabetic patients for neuropathy, nephropathy, hypertension, dyslipidemia and other diabetic complications as well.

Achieving glycemic control and targets are challenging in type-1 diabetes management. To achieve this, intensive insulin therapy or multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) or pump therapy have been used in various health care settings. However, there has been a debate on their superiority. Some of researchers have recommended MDI, while others SCII. We compared MDI with CSII by a literature search. We have conducted mata-analysis for MDI and CSII on ten randomized controlled trials on 809 type-1 diabetics 809, MDI (N = 394) or CSII (N = 415). Heterogeneity between trials was quantified by conventional Q-statistic (Cochran’s heterogeneity statistic) and Higgins I2 statistic with 0-40% representing negligible heterogeneity, 30-60% moderate heterogeneity, 50-90% substantial heterogeneity and 75-100% considerable heterogeneity. tau-squared (τ2) was used to observe between-study random-effects variance. Meta Analyst software was used to analyze the data and to conduct meta-analysis. SPSS was used to analyze HbA1c student’s t-test for MDI and CSII. A random-effect analysis ((DerSimonian-Laird method) performed on ten studies found that the percentage of HbA1c was lower in patients receiving CSII compared with those receiving MDI; standardized mean difference (SMD) was 0.441, 95% confidence interval 0.267 to 0.616, p < 0.001; equivalent to a difference of 0.39%, favoring CSII. I2 statistic was 20.9; τ2 = 0.016; Q = 11.378 with df = 9, indicating that heterogeneity was not significant (heterogeneity p-value = 0.251). Patients on CSII demonstrated significantly lower values (8.2±0.72 versus 7.73±0.72; p-value < 0.001 respectively). This statistical and meta-analysis favors the usage of insulin pump therapy. We concluded that patient centered approach should be used while selecting the patients for insulin pump (CSII) or MDI.

Modern vessels increasingly rely on the Automatic Identification System (AIS) digital technology to wirelessly broadcast identification and position information to neighboring vessels and ports. AIS is a time-slotted protocol that also provides unicast messages–usually employed to manage self-separation and to exchange safety information. However, AIS does not provide any security feature. The messages are exchanged in clear-text, and they are not authenticated, being vulnerable to several attacks, including forging and replay. Despite the existing contributions in the literature propose some strategies to overcome the exposed weaknesses, some are insecure, others do not comply with the standard, while the remaining few ones would introduce an unacceptable overhead–that is, they would require a relevant number of AIS-time slots, because of the limited payload available for each time-slot. In this paper, we propose SecureAIS, a key agreement scheme that allows any pair of vessels in reach of an AIS radio to agree on a shared session key of the desired length, by requiring just a fraction of the AIS time-slots of competing solutions. Further, the scheme is fully standard compliant and does not require any modification to the available hardware. The proposed scheme integrates the Elliptic Curve Qu-Vanstone (ECQV) implicit certification scheme and the Elliptic Curve Diffie Hellman (ECDH) key agreement technique, requiring moderate computational overhead while enjoying an optimal usage of the available bandwidth. When configured with the highest security level of 256 bits, SecureAIS allows two AIS transceivers to agree on a shared session key in 20 time-slots, against the 96 time-slots required by the competing solution based on traditional X.509 certificates. The proposed solution has been implemented and tested in a real scenario, while its security has been formally evaluated through the ProVerif tool. Finally, the source code of our Proof-of-concept using GNURadio and Ettus Research X310 has been also released as open-source to pave the way to further research by both Industry and Academia in maritime communication security.

Severe combined immunodeficiency (SCID) is a heterogeneous group of primary immunodeficiency diseases (PIDs) characterized by a lack of autologous T lymphocytes. This severe PID is rare, but has a higher prevalence in populations with high rates of consanguinity. The epidemiological, clinical, and immunological features of SCIDs in Moroccan patients have never been reported. The aim of this study was to provide a clinical and immunological description of SCID in Morocco and to assess changes in the care of SCID patients over time. This cross-sectional retrospective study included 96 Moroccan patients referred to the national PID reference center at Casablanca Children’s Hospital for SCID over two decades, from 1998 to 2019. The case definition for this study was age

Background: In patients with increased bleeding risk, the biolimus A9-coated BioFreedom stent, a stainless steel drug-coated stent free from polymer, has shown superiority compared with a bare-metal stent. The aim of this study was to investigate whether the BioFreedom stent is noninferior to a modern ultrathin strut biodegradable polymer cobalt-chromium sirolimus-eluting Orsiro stent in an all-comers patient population treated with percutaneous coronary intervention. Methods: The SORT OUT IX trial (Scandinavian Organization for Randomized Trials With Clinical Outcome IX), was a large-scale, registry-based, randomized, multicenter, single-blind, 2-arm, noninferiority trial. The primary end point, major adverse cardiovascular events, was defined as the composite of cardiac death, myocardial infarction not related to any segment other than the target lesion, or target lesion revascularization within 1 year, analyzed by intention-to-treat. The trial was powered to assess noninferiority for major adverse cardiovascular events of the BioFreedom stent compared with the Orsiro stent with a predetermined noninferiority margin of 0.021. Results: Between December 14, 2015 and April 21, 2017, 3151 patients were assigned to treatment with the BioFreedom stent (1572 patients, 1966 lesions) or to the Orsiro stent (1579 patients, 1985 lesions). Five patients were lost to follow-up because of emigration (99.9% follow-up rate). Mean age was 66.3±10.9, diabetes mellitus was seen in 19.3% of patients, and 53% of the patients had acute coronary syndromes. At 1 year, intention-to-treat analysis showed that 79 (5.0%) patients, who were assigned the BioFreedom stent, and 59 (3.7%), who were assigned the Orsiro stent, met the primary end point (absolute risk difference 1.29% [upper limit of one-sided 95% CI 2.50%]; P noni nferiority =0.14). Significantly more patients in the BioFreedom stent group had target lesion revascularization than those in the Orsiro stent group (55 [3.5%] vs 20 [1.3%], rate ratio 2.77 [95% CI, 1.66–4.62]; P Conclusions: The biolimus A9-coated BioFreedom polymer-free stent did not meet criteria for noninferiority for major adverse cardiovascular events at 12 months when compared with the ultrathin strut biodegradable polymer sirolimus-eluting Orsiro stent in an all-comers population Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02623140.

Biomarkers are indicators of pathogenic processes, typical biological processes, or pharmacological reactions to a therapy. It has several potential usages in cancer; differential diagnosis, prognosis, risk assessment, therapeutic response, and monitoring of disease progression. Recently, advances in oncomarkers raised significant opportunities for enhancing management of cancer. Chromosomal aberration, molecular impairment and epigenetic alteration might be applied to diagnose and prognose cancer and its epidemiology. Some oncomarkers are specific and highly sensitive for detection. An oncomarker might be used to see how the body reacts to an intervention or a situation. The present study represents a short review about various genetic oncomarkers with diagnostic and prognostic values.

Power curve, the functional relationship that governs the process of converting a set of weather variables experienced by a wind turbine into electric power, is widely used in the wind industry to estimate power output for planning and operational purposes. Existing methods for power curve estimation have three main limitations: (i) they mostly rely on wind speed as the sole input, thus ignoring the secondary, yet possibly significant effects of other environmental factors, (ii) they largely overlook the complex marine environment in which offshore turbines operate, potentially compromising their value in offshore wind energy applications, and (ii) they solely focus on the first-order properties of wind power, with little (or null) information about the variation around the mean behavior, which is important for ensuring reliable grid integration, asset health monitoring, and energy storage, among others. In light of that, this study investigates the impact of several wind-and wave-related factors on offshore wind power variability, with the ultimate goal of accurately predicting its first two moments. Our approach couples OpenFAST—a multi-physics wind turbine simulator—with Gaussian Process (GP) regression to reveal the underlying relationships governing offshore weather-to-power conversion. We first find that a multi-input power curve which captures the combined impact of wind speed, direction, and air density, can provide double-digit improvements, in terms of prediction accuracy, relative to univariate methods which rely on wind speed as the sole explanatory variable (e.g. the standard method of bins). Wave-related variables are found not important for predicting the average power output, but interestingly, appear to be extremely relevant in describing the fluctuation of the offshore power around its mean. Tested on real-world data collected at the New York/New Jersey bight, our proposed multi-input models demonstrate a high explanatory power in predicting the first two moments of offshore wind generation, testifying their potential value to the offshore wind industry.

Statistical quality control in semiconductor manufacturing hinges on effective diagnostics of wafer bin maps, wherein a key challenge is to detect how defective chips tend to spatially cluster on a wafer--a problem known as spatial pattern recognition. Recently, there has been a growing interest in mixed-type spatial pattern recognition--when multiple defect patterns, of different shapes, co-exist on the same wafer. Mixed-type spatial pattern recognition entails two central tasks: (1) spatial filtering, to distinguish systematic patterns from random noises; and (2) spatial clustering, to group filtered patterns into distinct defect types. Observing that spatial filtering is instrumental to high-quality mixed-type pattern recognition, we propose to use a graph-theoretic method, called adjacency-clustering, which leverages spatial dependence among adjacent defective chips to effectively filter the raw wafer maps. Tested on real-world data and compared against a state-of the-art approach, our proposed method achieves at least 46% gain in terms of internal cluster validation quality (i.e., validation without external class labels), and about ~5% gain in terms of Normalized Mutual Information--an external cluster validation metric based on external class labels. Interestingly, the margin of improvement appears to be a function of the pattern complexity, with larger gains achieved for more complex-shaped patterns.

The compressive sensing method presents itself as a promising technique in many fields specially for the Internet of Things and Wireless sensor networks applications. That is because, the compressive sensing has the major advantage of performing lightweight encryption and compression simultaneously. It leads to secure the network in addition to prolong the network life time. However, chosen plaintext attacks and key distribution are still major challenges facing the compressive sensing method. This paper focuses on the compressive sensing method according to security issue, and propose an efficient lightweight security scheme that addressee the previous challenges. Moreover, we use experimental data collected from a real sensors located in Intel Berkeley Research Lab.

Background and aim Ginkgo biloba (GKB) extract has shown to be beneficial in experimental models of metabolic and inflammatory disorders such as diabetes and metabolic syndrome (MTS). The objective of this pilot clinical study was to evaluate the effects of GKB extract as an "add-on" treatment with metformin (Met) in MTS patients. Patients and methods We performed a randomized, placebo-controlled, double-blinded clinical study in subjects with MTS. Forty patients completed the 90-day clinical trial and were randomly allocated to administer either GKB extract (120 mg capsule/day) or placebo (120 mg starch/day) as an add-on treatment with their currently used doses of Met for 90 days. During the study, body mass index (BMI), waist circumference (WC), serum leptin, glycated hemoglobin (HbA1c), fasting serum glucose (FSG), insulin, insulin resistance (IR), visceral adiposity index (VAI), lipid profile, and the inflammatory markers high sensitive C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were evaluated. Results GKB extract significantly decreases HbA1c, FSG and insulin levels, IR, BMI, WC, VAI, serum leptin, and the inflammatory markers compared to baseline values. Simultaneously, GKB did not negatively affect the functions of the liver, kidney, and hematopoietic system. Conclusion The use of GKB extract as an adjuvant with Met was effective in improving the outcome of patients with MTS.

Overcrowding in Emergency Department usually results in serious consequences such as delay in facilities, medical errors and medical complications as well. This occurs because delay in transfer of the patients from ED to inpatient departments. We conducted this study to know patients’ and their attendants preferences to stay in ED or to be shifted to in-patient units. Data was collected via Arabic translated questioner. A total of 316 applicants included in the study (after inclusion / exclusion criteria), 144 patients with 157 patient attendants. 75 (52.1%) were male, while 69 (47.9%) were females. The preferred area for boarding was ED curtained space for 77.8% of patients and 79% of patient watcher as compared to 11.8% patients and 15.3% attendants who accepted the admission to inpatient hallway (p- value 0.253). Regarding the comparison of boarding time (8 hours and 24 hours), 55.5% of patients preferred in ED with 8 hours scenario versus 29.9% who preferred inpatient hallway (p=0.0897). When 24 hours scenario was compared, it was found that 59% patients preferred ED while 49.7% preferred inpatient hallway (p= 0.252). Current study proves that collectively patients prefer to stay in ED (either curtained space or hallway); this is because the patients received quick facilities and attention from the staff. However, with 24 hours scenario, more patients now preferred to stay in in-patient hallway; this is because of delay in transfer of the patients from ED, and delay or lack in facilities which usually occur during overcrowding. We concluded that patient and their preferences differ in different settings. However, overcrowding in ED should be dealt seriously with transfer of patients to in-patient departments / wards as soon as possible to avoid medical errors and complications.

Alpha-1 antitrypsin deficiency is an autosomal, codominant disorder caused by mutations of the SERPINA1 gene. This genetic disorder is mainly associated with development of pulmonary emphysema and/or chronic liver disease and cirrhosis.Here we report a very rare alpha-1 antitrypsin Null Q0cairo homozygous mutation characterized by a complete absence of alpha-1 antitrypsin in the plasma, in a non-consanguineous Moroccan family. This mutation has been previously described in heterozygosis in only three cases worldwide: an Italian/Egyptian family and two Italian families (Zorzetto et al., 2005). The main clinical features in two members of this Moroccan family were the severity and precocity of bronchiectasis, quickly spreading and seriously limiting respiratory function and physical activity by the second decade of age. Moreover, the index case presented with many episodes of pulmonary infections concomitant with severe neutropenia. The third member of the family presented with ankylosing spondyloarthritis and developed panniculitis later but had no respiratory symptoms.The presence of this alpha-1-antitrypsin Q0cairo homozygous mutation could explain the severity of clinical manifestations. Moreover, our observations highlight a great variability of clinical expression for the same mutation: early severe bronchiectasis, panniculitis, rheumatologic manifestations. This study further underlines the importance of genotyping by whole SERPINA1 gene sequencing in addition to serum alpha-1 antitrypsin determination, to enable detection of alpha-1 antitrypsin deficiency due to rare genotypes. Keywords: Alpha-1 antitrypsin deficiency, Bronchiectasis, Panniculitis, Null mutation, SERPINA1 genotyping

BACKGROUND: Coronary vasomotor dysfunction is an important mechanism for angina in patients with unobstructed coronary arteries.OBJECTIVES: The purpose of this study was to determine sex differences in the prevalence and clinical presentation of vasomotor dysfunction in a European population and to examine sex differences in the dose of acetylcholine leading to a positive acetylcholine provocation test (ACH test).METHODS: Between 2007 and 2014, we included 1,379 consecutive patients with stable angina, unobstructed coronaries and ACH test performed for epicardial vasospasm or coronary microvascular dysfunction (CMD) due to microvascular spasm. The predictive value of sex, risk factors, symptoms, and noninvasive test results was analyzed by means of logistic regression.RESULTS: The mean patient age was 62 years, and 42% were male. There were 813 patients (59%) with a pathological ACH test, 33% for CMD and 26% for epicardial vasospasm. A pathological test was more common in females (70% vs. 43%; p < 0.001). In a multivariable logistic regression model the sex difference was statistically significant with a female-male odds ratio for CMD and epicardial vasospasm of 4.2 (95% confidence interval: 3.1 to 5.5; p < 0.001) and 2.3 (95% confidence interval: 1.7 to 3.1; p < 0.001), respectively. Effort-related symptoms, but neither risk factors nor noninvasive stress tests, contributed to predicting a pathological test. Female patients were more sensitive to acetylcholine with vasomotor dysfunction occurring at lower ACH doses compared with male patients.CONCLUSIONS: Vasomotor dysfunction is frequent in patients with angina and unobstructed coronaries in a European population. Female patients have a higher prevalence of vasomotor dysfunction (especially CMD) compared with male patients. A pathological ACH test was observed at lower ACH doses in women compared with men.

A correction to this paper has been published: https://doi.org/10.1007/s10875-021-01058-8 .